Esophageal spasms

Esophageal spasms are painful contractions within the muscular tube connecting your mouth and stomach (esophagus). Esophageal spasms can feel like sudden, severe chest pain that lasts from a few minutes to hours.

Esophageal spasms typically occur only occasionally and might not need treatment. But sometimes the spasms are frequent and can prevent food and liquids from traveling through the esophagus. If esophageal spasms interfere with your ability to eat or drink, treatments are available.

When to see a doctor

Esophagus

It's not clear what causes esophageal spasms. However, they appear to be related to abnormal functioning of nerves that control the muscles you use when you swallow.

A healthy esophagus normally moves food into your stomach through a series of coordinated muscle contractions. Esophageal spasms make it difficult for the muscles in the walls of your lower esophagus to coordinate in order to move food to your stomach.

There are two types of esophageal spasms:

Occasional contractions (diffuse esophageal spasms). This type of spasm may be painful and is often accompanied by regurgitation of food or liquids.

Painfully strong contractions (nutcracker esophagus). Although painful, this type of spasm — also referred to as jackhammer esophagus — may not cause regurgitation of food or liquids.

Endoscopy. A flexible tube (endoscope) that is passed down your throat allows your doctor to see the inside of the esophagus. Your doctor may remove a tissue sample (biopsy) for testing to rule out other esophageal diseases.

X-ray. Images of your esophagus are taken after you swallow a contrast liquid.

Esophageal manometry. This test measures muscle contractions in your esophagus when you swallow water

Esophageal pH monitoring. This test can determine if stomach acid is flowing back into your esophagus (acid reflux).

Endoscopy

If your spasms make it difficult to eat or drink, your doctor might recommend:

Managing any underlying conditions. Esophageal spasms are sometimes associated with conditions such as heartburn, GERD, anxiety or depression. Your doctor might recommend a proton pump inhibitor — such as lansoprazole — to treat GERD, or an antidepressant, such as trazodone or imipramine (Tofranil). Antidepressants might also help reduce the sensation of pain in the esophagus.

Surgery (myotomy). If medication doesn't work, your doctor might recommend a procedure that involves cutting the muscle at the lower end of the esophagus, to weaken esophageal contractions. Long-term studies of this approach aren't available, so myotomy generally isn't recommended for esophageal spasms. However, it might be considered if other treatments don't work.

Peroral endoscopic myotomy (POEM). In this new minimally invasive technique, an endoscope inserted through your mouth and down your throat allows an incision in the inside lining of your esophagus. Then, as in myotomy, the surgeon cuts the muscle at the lower end of the esophagus. Like myotomy, POEM is usually considered only if other treatments don't work.